ROCHESTER — A review by Foster’s Daily Democrat has found emergency calls for ambulances service in Rochester have been on the rise since 2007 and, to some extent, may be stretching the community and mutual aid resources available to handle the calls.

Foster’s has learned from local fire chiefs the increase has meant firefighters and paramedics have had to take on an additional workload in Rochester and from surrounding communities, but that increase has not prompted an increase in resources or staff.

At this time officials say the current coverage is adequate.

According to data available from the region’s dispatch center, which coordinates the transporting of patients to Frisbie Memorial Hospital Hospital, emergency medical service (EMS) calls have gone up 35 percent, from 3,741 in 2007 to 5,056 as of November 2012.

Frisbie Memorial Hospital’s ambulance service is the primary responder for medical calls in the city of Rochester. Other departments are called in for mutual aid when necessary.

Calls for mutual aid regarding medical service in Rochester have more than doubled in the last five years, from nine requests in July 2007 to 20 in July 2012, according to numbers provided by the local dispatch center. In October 2007, there was a call for mutual aid eight times as compared to the same month in 2012, which had 27 requests as well.

Rochester Fire Department Chief Norman Sanborn, confirming the rise in calls, said he has not heard complaints from any of the other fire departments that provide mutual aid, including additional ambulance service, to the city of Rochester.

The included in the regional mutual aid agreement with Frisbie are the Farmington Fire Rescue Department, the City of Dover Fire & Rescue, American Medical Response (AMR) based out of Somersworth, Barrington Fire & Rescue, Milton Fire & Rescue and the Lebanon Rescue Department in Maine.

“We’d all love to have more people but we make it work…,” Sanborn noted. “You make it work with what you’ve got.”

The current system

Frisbie Memorial Hospital has a contract in place with the city of Rochester that says it will provide ambulance service primarily to the Lilac City 24/7. The current contract was put into effect in 1998 and recently extended to 2021. In it, the hospital agrees to provide two ambulances all day, every day, in three shifts, or to make provisions for two ambulances to always be on call from other towns, including by means of mutual aid.

Sanborn and Frisbie EMS staff confirmed while two staffed ambulances are on call from 7 a.m. to 3 p.m. for the first shift, and the second shift from 3 p.m. to 11 p.m., there is only one staffed ambulance for the 11 p.m. to 7 a.m. shift along with Frisbie’s intercept vehicle. That singular ambulance has been assigned to the late night shift since Frisbie began providing ambulance services to Rochester in 1980, according to Frisbie Vice President of Planning and Project Management Joe Shields.

Frisbie Memorial Hospital representatives said the operation of one ambulance and the intercept vehicle for the third shift is not a breach of the city’s contract with the nonprofit hospital, because other mechanisms are in place to provide assistance to Rochester, should several calls come in at once.

Frisbie must have at least one advanced life support ambulance and one basic life support ambulance in service or “take necessary steps to ensure the same level of ambulance protection is available” according to the contract.

The intercept vehicle, a black pickup truck staffed with one medic and regular ambulance supply, is on call throughout all shifts regularly, except between the hours of 7 a.m. and 11 a.m. It was brought on in October 2009 to respond to incidents in Rochester and surrounding towns without sending out a full ambulance. Sanborn explained most times, departments requesting the service only need one paramedic and advance life support ambulance equipment, and it was wasteful to send a full ambulance in the past, with two paramedics aboard.

Frisbie staff noted since the intercept vehicle joined the hospital’s resources in 2009, the occasions for which a Frisbie ambulance is sent to neighboring towns has reduced by more than four times. The truck reportedly responds to calls about 850 times a year, both inside and outside of Rochester, they say.

“That might be the issue that people are looking at,” Sanborn added, when asked whether staff in Rochester and other towns are feeling overworked, “… (but) we don’t feel that’s an issue because what happens is we get the medic truck and we get the firefighters (to an incident), to stabilize the patient and by the time the patient is stabilized, the mutual aid is there and then they transport.”

Sanborn noted in Rochester, all firefighters are trained by Frisbie staff at the basic level for medical response. For his department, he said he has observed the least number of emergencies occurring during the third late-night shift. When the intercept vehicle is tied up in another community and a town requests advance life support from Frisbie, the hospital will send a full ambulance to that town through dispatch communications.

“There are some times at night when it does get busy, though,” Sanborn added. “I’m not going to say it doesn’t, but that’s when (Frisbie) has got to use mutual aid … and it does happen.”

John Levitow, director of Frisbie’s emergency nursing and EMS department, said in general, about 33 percent of medical calls to Frisbie do not require transport to the hospital and in the hospital’s view, only having one ambulance staffed during the night is not a violation of the hospital’s responsibilities to the Lilac City. Frisbie EMS also responds to various other towns outside of the towns that currently provide mutual aid to Rochester.

Levitow added during the third shift, the types of calls received — typically having to do with assault and domestic disturbances — usually do not result in a need to transport a patient to the hospital.

How mutual aid and service works for Frisbie

Levitow explained Rochester is divided geographically into four regions — it’s a system that helps determine which mutual aid department will be called when Frisbie’s ambulances are tied up. For each region, there is a first, second, and third choice of which agency would provide mutual aid. Ideally, the closest agency to the incident would respond, but if that department is tied up as well, then Frisbie requests mutual aid from the second choice.

“We work closely with area communities,” said Gary Brock, assistant director of EMS at Frisbie. “We depend on each other for things.”

While Rochester is the only town with which Frisbie has a contract for ambulance services, the hospital also provides mutual aid to neighboring towns that don’t have as many resources, particularly when it comes to having paramedics on staff. Brock explained that EMTs typically have at least 150 hours of classroom training, while paramedics have about two years of classroom and clinical training experience. During serious medical calls, smaller towns have to rely on services from Rochester, Dover and AMR for their paramedics to arrive on scene.

Frisbie Memorial Hospital has 38 paramedics, and one intermediate EMT who has had an extra 100 hours of training. That person partners with a paramedic when going out to medical calls.

Sanborn described the mutual aid coordination throughout the region as one based on “teamwork.”

“We figure as a team, we’re going to do whatever it takes to save somebody’s life and that’s our goal,” he said.

Sanborn noted even with a high increase in calls, the department has not experienced a lag time in response. According to Shields, the city’s contract with the hospital requires Frisbie staff to respond to medical incidents within 10 minutes for 90 percent of the time. Shields said that Frisbie’s average response time is 5 minutes and 25 seconds.

Sanborn also pointed to the city’s recent “HeartSafe” award. In February, the state awarded Rochester with the HeartSafe stamp, for survival rates of cardiac arrests reported in 2011. Frisbie previously told Foster’s the survival rate in Rochester for a patient is four times higher than the national average, with a 28 percent survival rate recorded in 2010, as compared to the country’s average 6 percent rate. Rochester is one of 14 communities in New Hampshire to have the designation.

Frisbie staff say this achievement could not have been possible without the community’s emphasis on teamwork with various agencies.

A response from local officials

In interviews with Foster’s, several local chiefs and fire officials said they feel the departments have been handling the rise in calls well. They claim have one Frisbie ambulance available during the third shift does not negatively affect their mutual aid operations.

Farmington Fire Rescue Chief Rich Fowler said he recalled a time before he took over as chief when there was an apparent “abuse” of the mutual aid system, on Farmington’s end, around 2001. He said the town requested service from Frisbie hundreds of times a year, and only reciprocated a handful of other times in the Lilac City. Fowler said today, the kinks have been worked out and he feels Farmington and Rochester truly have a “mutual” agreement in place, assisting one another when it is necessary.

“That was an abuse of the system...” he said, referring to that period of time. “That’s when Frisbie said… ‘This is not mutual aid. This is Frisbie handling the daily EMS calls in Farmington.’ So they called for a solution and we have called for a solution. We’ve moved to part-time positions and we’ve grown to where we are today.”

The small Farmington fire department relies heavily on volunteers as well, and Fowler commended his staff’s diligent work. He said he does not believe the current system today puts additional stress on his workers.

In Barrington, Fire & Rescue Chief Rick Walker said his department “couldn’t survive” without Frisbie’s assistance in their mutual aid system. The Barrington department does not have the staffing or the resources to have more than one ambulance, Walker said, and typically has to rely on Frisbie, McGregor Memorial EMS, or at times Dover and Strafford EMS departments when a second ambulance is needed.

The call volume, Walker added, does not currently show a need for two Barrington ambulances, but that’s a question that has to be re-evaluated on a regular basis. Eighty percent of the time when paramedic services are needed, either Frisbie or McGregor Memorial EMS responds. Walker said Barrington only has one paramedic, who works full-time in another community.

“We rely pretty heavily on (Frisbie) as a second due ambulance,” he explained.

Bruce Snyder, president of the Rochester Firefighters’ Association, added he has not heard from his local firefighters there is an issue with the current system in place.

“When the call comes in, it’s not a question of, ‘Should we decide to go or not?’ It’s not a question of whether we’re tired. The run volume speaks for itself,” Snyder said. “ … The call volume is the call volume. Sometimes we do one run and sometimes we do 10 runs … It is what it is.”

Dover Fire & Rescue Chief Richard Driscoll said his department was designated as the primary responding ambulance service for Rochester’s mutual aid requests in early 2011 and since then, he has seen a rise in times his staff has been called out. According to data provided by the department, Dover provided mutual aid to Rochester 39 times, for both medical and fire-related calls, from January to November in 2012, compared to 4 times in 2008, 19 in 2009, 6 in 2010 and 23 in 2011. Dover’s response to Rochester accounts for less than 1 percent of their calls though, with nearly 4,400 calls in the year for medical and fire-related incidents for the department as of November.

Dover staffs 11 to 12 firefighters at all times, compared to the Rochester Fire Department, which staffs eight. Dover has its own ambulance service, with two ambulances and a crossover staff from the fire service for the second ambulance needed on a second call. All firefighters there are trained at a higher level of EMT response, at a paramedic level as a minimum requirement.

Driscoll noted with the lack of an ambulance in Rochester during the third shift late hours, he has not personally noticed a rise in calls for his crew to respond.

“The funny thing with ambulance calls is … it’s a crapshoot,” Driscoll said. “There’s no method to figuring out when the calls are going to come in.”

A rise in emergency calls

From figures provided by the Rochester Fire Department, the total number of annual medical runs the department makes to assist Frisbie has gone up, from 1,983 calls in 2008 to 2,206 in 2012. Rochester’s data system only tracks information going back to 2008, Sanborn noted.

The number of medical assist calls, in which Rochester firefighters assist Frisbie’s EMS crew, has more than doubled in the last four years, from 218 calls in 2008 to a whopping 588 in 2012 as of data released in mid-December.

Sanborn and Frisbie officials say the rise in calls can be tracked to the nature of the economy. Fewer people can afford proper health care, and they rely on ambulances and emergency rooms to take the place of a primary care doctor, he said.

Sanborn also pointed to the growing and aging population in Rochester. Around 2005 and 2006, the fire department approached Frisbie and asked to take on more responsibility, he said. Sanborn said the department requested a “first responder role” on medical calls, given the fact that Rochester firefighters have basic EMT training. From there, the department took on a greater volume.

Frisbie staff said the Rochester Fire Department has taken on more calls today “because they asked,” Brock said.

“That’s part of building a system,” Brock explained. “The outcome is going to be better if a half dozen people are there rather than the two paramedics.”

“They requested it because it was a good idea,” Shields added.

The need for another ambulance?

As the number of EMS calls has increased in Rochester over the years, the percentage of times when Frisbie responds to incidents with its own ambulance, with no mutual aid, has stayed pretty stable— around 3 percent or below, according to provided figures.

“Our target is to keep that percentage low,” said Brock. “We are looking at this every month, every year.”

Through November, mutual aid responded to 3.5 percent of all medical calls in Rochester during 2012, according to figures provided by Rochester’s dispatch center. That equals a total of about 178 times out of 5,056 calls for EMS according to data provided in November.

With mutual aid ambulances coming in about 3 percent of the time, Levitow said it would not be practical for Frisbie to purchase another ambulance. Brock also point out based on an informal query he conducted, other ambulance services across the country ask for mutual aid around 10 to 25 percent of the time.

Brock said that another ambulance is not being considered because the calls for EMS tend to be spread out as well, and are not concentrated during one time period. This means that Frisbie Memorial Hospital does not typically need multiple ambulances at once.

Levitow also noted that about one-third of EMS calls do not require an ambulance transport. He said he’s not certain when Frisbie officials would begin discussing the necessity of an additional ambulance, but that it would depend on the volume of EMS calls and the hospital’s ability to handle those calls.

“We have looked at our volumes and we have addressed those volumes (through placing into service the paramedic intercept vehicle),” he said.

Dover is experiencing a similar rise in calls, Driscoll said. The department is constantly approaching the Dover City Council to review the budget to see what can be done but he said taking on another ambulance at this time is not an option for his department.

“We have addressed it a couple of times, but right now, we know where the budgets are and we’re limited,” Driscoll said.

Driscoll said this past November the Dover department responded to “simultaneous calls,” or two incidents at the same time, 65 times. That month, at 18 different times, there were three or four incidents being called in at once as well.

In Rochester, Sanborn said he believes the ambulance system with mutual aid is “well-oiled,” though his department could always use a little more help.

“We could always use more people but we understand in these economic times, we’re trying to maintain what we’ve got,” Sanborn said. “Where the economy’s been the last few years, it’s hard to go in and ask for additional people.”

In the next one to two years, Sanborn noted his department will consider taking on new positions and at least eight or 10 years from now, there are plans for taking on a third station in the northern part of the city.